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find Author "刘梅" 13 results
  • 7262例体外循环管理经验总结

    目的总结体外循环(CPB)管理的经验及教训,为更安全的CPB方式提供参考。方法回顾性分析我院1964年2月~2004年12月施行的CPB心内直视手术7262例患者的临床资料,并对硬件设备、转流技术、灌注师经验、术中监测及心肌保护等方面进行分析,其中3748例患者采用心脏不停跳CPB。结果全组死亡248例,总死亡率3.4%(248/7262)。1964年2月~1983年12月施行CPB手术464例,死亡52例,死亡率11.2%;1984年1月~1996年12月施行CPB手术1709例,死亡78例,死亡率4.6%;1997年1月~2004年12月施行CPB手术5089例,死亡118例,死亡率2.3%;1997年3月~2004年12月,对3748例患者采用心脏不停跳CPB,手术顺利,未发生与CPg相关的并发症及死亡。结论灌注师的经验和硬件设备的完善、使用高质量的人工心肺机和氧合器、多种转流技术的应用、完善的监测系统等可明显提高CPB的安全性。心脏不停跳下CPB是安全且易于管理的一种方式。

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 婴幼儿与成人体外循环管理比较

    目的 为了婴幼儿心内直视手术顺利进行,探讨其体外循环(ECC)的特点。方法 对近3年来施行的59例10kg以下婴幼儿ECC进行总结,并与同期205例成人ECC进行比较。结果 婴幼儿组死亡5例,成人组死亡5例。两组术中均未发生ECC意外和与其相关的并发症。其中成人组在转流时间、阻断时间、预充液用量、钾用量、碳酸氢钠用量、库血用量、转流中尿量等方面明显高于婴幼儿组(P<0.05和P<0.01);而转流中流量和使用库血例数则较婴幼儿组明显减少(P<0.01),整个ECC期间婴幼儿组血气改变较大,特别是在转流20分钟时较明显(P<0.05);两组对血钾的影响差别无显著性意义。结论 对婴幼儿ECC应采用高流量灌注,应用高质量膜肺,并注意心肌保护,酸碱平衡和电解质平衡,预充液应选择不含糖溶液。

    Release date:2016-08-30 06:33 Export PDF Favorites Scan
  • The preliminary value of vector flow mapping on assessment of left intraventricular pressure difference in patients with paroxysmal atrial fibrillation

    This study aims to explore the intraventricular pressure difference (IVPD) within left ventricle in patients with paroxysmal atrial fibrillation (PAF) by using the relative pressure imaging (RPI) of vector flow mapping (VFM). Twenty patients with paroxysmal atrial fibrillation (PAF) and thirty control subjects were enrolled in the study. Systolic and diastolic IVPD derived from VFM within left ventricle and conventional echocardiographic parameters were analyzed. It was found that the B-A IVPD of left ventricle in PAF patients showed the same pattern as controls—single peak and single valley during systole and double peaks and double valleys during diastole. Basal IVPD was the main component of base to apex IVPD (B-A IVPD). The isovolumetric systolic IVPD was associated with early systolic IVPD, early systolic IVPD was associated with late systolic IVPD, and late systolic IVPD was associated with isovolumic diastolic IVPD (all P < 0.05). The B-A IVPD and basal IVPD during isovolumetric systole, early systole, late systole and isovolumetric diastole in PAF patients significantly decreased (all P < 0.05). The study shows that the B-A IVPD pattern of the PAF group is the same as controls, but systolic B-A IVPD and basal IVPD are significantly reduced in PAF patients. VFM-derived RPI can evaluate left ventricular IVPD in PAF patients, providing a visually quantitative method for evaluating left ventricular hemodynamic mechanics in the patients with PAF.

    Release date:2021-06-18 04:50 Export PDF Favorites Scan
  • 以疼痛为唯一表现的梅毒性脊髓炎一例

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  • 早期应用无创通气治疗慢性阻塞性肺疾病急性加重疗效观察

    随着无创机械通气技术在临床的广泛应用及技术水平的不断提高,已取得了可靠有效的临床疗效。无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭,更是弥补了传统治疗的不足,早期应用治愈率高,死亡率低[1]。本文总结了大连市中心医院近两年使用NPPV治疗慢性阻塞性肺疾病急性加重(AECOPD)的情况,探讨AECOPD早期应用无创通气的价值及疗效。

    Release date:2016-09-14 11:53 Export PDF Favorites Scan
  • Risk Factors for Stroke Associated Pneumonia: A Prospective Study

    Objective To investigate the risk factors of stroke associated pneumonia in stroke patients.Methods A case-control study was conducted. 114 patients who were diagnosed stroke associated pneumonia between January 2008 and December 2010 were recruited as a patient group. 205 patients who were diagnosed stroke without pneumoniawere recruited as a control group. General conditions, accompanied disease, vital sign, hematologic marker, severity of stroke, and bulbar paralysis were compared between two groups. Multifactor Logistic regression was used to screen associated factors.Results Age gt; 65 years ( OR=3. 310, 95% CI 2. 016-7. 549) , accompanied with COPD ( OR = 3. 624, 95% CI 1. 574-9. 236) , diabetes ( OR= 3. 781, 95% CI 1. 305-6. 842) , failed water swallowing test ( OR = 3. 625, 95% CI 1. 604- 8. 386) , big volume of stroke ( OR=14. 784, 95% CI 3. 737-38. 588) , NIH stroke scale ( NIHSS) score gt;6 ( OR=2. 913, 95% CI 1. 029-7. 985) , abbreviated mental test ( AMT) score lt; 8 ( OR = 4. 229, 95% CI 2. 215-9. 368) were associated with stroke associated pneumonia. Conclusion The risk factors for stroke associated pneumonia in stroke patients were age gt;65 years, accompanied with COPD, diabetes, failed WST, big volume of stroke, NIHSS score gt;6, and AMT score lt;8.

    Release date:2016-09-13 03:50 Export PDF Favorites Scan
  • Surgical Treatment of Cardiac Tumors:Clinical Analysis of 181 Patients

    Objective To investigate surgical treatment strategies and analyze clinical outcomes of cardiac tumors. Methods Clinical data of 181 patients with cardiac tumors who underwent surgical treatment in Xinqiao Hospital of Third Military Medical University from January 1980 to December 2010 were analyzed retrospectively. There were 79 malepatients and 102 female patients with their age of 10 months-76 years (45.22±18.21 years) . A total of 179 patients underwent180 tumor resection surgeries under cardiopulmonary bypass (CPB). Two patients with malignant tumors did notreceive surgical resection but exploratory thoracotomy. All the tumor specimens were examined by pathologists. ResultsThere were 169 patients (93.4%) with primary cardiac tumors, including 144 patients (79. 6%) with myxoma, 20 patients (11.0%) with other types of primary benign cardiac tumors, and 5 patients (2.8%) with primary malignant cardiac tumors. There were 12 patients (6.6%) with secondary cardiac tumors. There were 2 perioperative deaths (1.1%) in patients with primary cardiac tumors,including 1 patient with low cardiac output syndrome and another patient with postoperative multipleorgan dysfunction syndrome. All the 5 patients with primary malignant tumors died in postoperative 12 months. Patients with benign cardiac tumors were followed up for 6 months-15 years (2.41±1.08 years) without tumor recurrence. Among patients with secondary cardiac tumors,there was 1 perioperative death because of postoperative multiple organ dysfunction syndrome,2 patients died within postoperative 1 year, and 3 patients died in the 3rd postoperative year during follow-up. Conclusion Myxoma is the most common cardiac tumor. Complete surgical resection is the best treatment strategy forpatients with cardiac tumors. Clinical outcomes of patients with benign cardiac tumors are significantly better than those with malignant cardiac tumors. Prognosis of patients with primary malignant cardiac tumors is poor.

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • Efficacy and Safety of Photodynamic Therapy on Cutaneous Bowen Disease: A Systematic Review

    Objective To assess the efficacy and safety of photodynamic therapy (PDT) for cutaneous bowen disease. Methods We electronically searched PubMed, OVID, Cochrane Central Register of Controlled Trials, CBM, and CNKI databases from January, 1966 to March, 2010. The language was confined to English and Chinese. We screened the retrieved randomized controlled trials (RCTs) according to the predefined inclusion criteria, evaluated the quality of the included studies, and performed meta-analysis with RevMan 5.0.23 software. Results Five RCTs were included; among all 496 skin leisions on 354 patients, 237 were in trial group while the other 259 were in control group. The healing rate of PDT was higher than that of both placebo (RR=4.16, 95%CI 1.69 to 10.25) and topical fluorouracil (RR=1.38, 95%CI 1.12 to 1.71), and was similar to that of cryotherapy. The cosmetic outcome evaluation of PDT was better than that of both cryotherapy (RR=1.48, 95%CI 1.18 to 1.87) and topical fluorouracil treatment (RR=1.51, 95%CI 1.05 to 2.15). The recurrence rate of PDT was lower than that of placebo (RR=0.29, 95%CI 0.10 to 0.86), and was similar with cryotherapy or topical fluorouracil treatment respectively. The healing rate of PDT with red light source was higher than that of PDT with green light (RR=1.29, 95%CI 1.02 to 1.65), and the recurrence rate of the former was lower than that of the latter (RR=0.20, 95%CI 0.05 to 0.87). There was no difference between 2-fold illumination scheme and single illumination scheme in the healing rate or the cosmetic outcome evaluation. The adverse effects include pain, cacesthesia, inflammatory reaction, hyperpigmentation, and crusting. Conclusion The limited evidence indicates that the efficacy of PDT is better than those of placebo, cryotherapy or topical fluorouracil treatment, the recurrence rate of PDT is lower than that of placebo, and the adverse effects are similar comparing to control groups. The PDT with red light source is superior to PDT with green light source for having better effectiveness, less recurrence and similar adverse effects. The 2-fold illumination scheme and single illumination scheme have similar efficacy, but the former is more painful.

    Release date:2016-09-07 11:09 Export PDF Favorites Scan
  • Probiotics-containing Rescue Regimen for the Eradication of Helicobacter Pylori Infection: A Systematic Review

    ObjectiveTo systematically review the efficacy and safety of probiotics-containing rescue regimen for the eradication of Helicobacter pylori (Hp) infection. MethodsWe electronically searched PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CBM, CNKI, WanFang Data and VIP databases, and Chinese Clinical Trial Register (ChiCTR) and ClinicalTrial.gov from inception to December 2015, to collect randomized controlled trials (RCTs) about probiotics-containing rescue regimen for the eradication of Hp infection. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsEleven RCTs involving 1888 patients were finally included. The results of meta-analysis showed that: Compared with the control group, probiotics-containing rescue regimen could significantly increase the eradication rate (ITT analysis: 80.3% vs. 69.3%, RR =1.15, 95%CI 1.10 to 1.22, P<0.00001; PP analysis: 86.5% vs. 74.3%, RR=1.16, 95%CI 1.11 to 1.22, P<0.00001), and decrease the incidence of total adverse reaction (ITT analysis: 19% vs. 29.2%, RR=0.60, 95%CI 0.40 to 0.91, P=0.02). Sensitivity analysis showed that the result was relatively stable. Publication bias test showed no evidence of substantial publication bias. ConclusionCurrent evidence indicates that probiotics-containing rescue regimen may contribute to improve eradication rate of Hp infection patients, and may reduce the occurrence of major gastrointestinal associated adverse reaction. Due to the limited quality and quantity of included studies, more high-quality RCTs are needed to verify the above conclusion.

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  • Application of methylene blue staining for precise positioning of small esophageal leiomyoma during video-assisted thoracoscopic surgery via one utility port

    Objective To develop a novel methylene blue staining technique to localize small esophageal leiomyomas (<1.5 cm) and evaluate its feasibility. Methods Between January 2013 and October 2016, 9 patients with small esophageal leiomyomas (<1.5 cm) underwent thoracoscopic enucleation in Tongji Hospital. There were 5 males and 4 females with an average age of 51 years. We preoperatively injected 0.5–1.0 ml methylene blue in the submucosa adjacent to the tumors under the guidance of gastroscope. Then, we transferred the patients to the operating room. Results Staining was successful in 9 patients. The unstained tumor was exposed after the blue-stained mediastinal pleura and overlying muscle were incised longitudinally during video-assisted thoracoscopic surgery via one utility port. No abnormalities were detected in the esophageal mucosa. No major complications, such as esophageal leakage or esophageal diverticulum occurred. Conclusion Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during video-assisted thoracoscopic surgery via one utility port. This method will enable enucleation precise and easy.

    Release date:2018-08-28 02:21 Export PDF Favorites Scan
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